Achilles Tendons: Clinical Relevance of Neovascularization Diagnosed with Power Doppler US

Zanetti, M.; Metzdorf, Alexander; Kundert, Hans-Peter; Zollinger, Hans Ulrich; Vienne, Patrick; Seifert, Burkhardt; Hodler, Juerg

doi:10.1148/radiol.2272012069

Cited by 230 publications

(197 citation statements)

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“…24,25 The absence of demonstrable vascularity on color Doppler imaging in healthy tendons is consistent with previous studies. 9,10,26 In current practice, there are several sonographic findings that may suggest a diagnosis of tendinopathy, including increase in tendon caliber, altered fibrillar echotexture, and increased tendon vascularity. 8,9 In our study, tendinopathic tendons were significantly larger than normal controls at the midportion of the tendon and at the calcaneal insertion.…”

Section: Discussionmentioning

confidence: 99%

“…9,10,26 In current practice, there are several sonographic findings that may suggest a diagnosis of tendinopathy, including increase in tendon caliber, altered fibrillar echotexture, and increased tendon vascularity. 8,9 In our study, tendinopathic tendons were significantly larger than normal controls at the midportion of the tendon and at the calcaneal insertion. The distal predominance for tendon swelling is different from that reported by Gibbon et al 8 in a cohort of similar age in which tendon swelling was primarily confined to the proximal two thirds of the Achilles tendon, though these differences may be explained by the semiquantitative measure used by the invesigators.…”

Section: Discussionmentioning

confidence: 99%

“…2 Sonography is commonly used to evaluate the Achilles tendon and paratendinous structures (subcutaneous tissues, Kager's fat pad [or preAchilles fat pad], bursae, calcaneal insertion, and plantar fascia). Although some features relating to chronic Achilles tendinopathy have been described previously, [7][8][9][10][11][12][13] there are no established sonographic diagnostic criteria for this entity. The purpose of our study was to analyze the sonographic appearances of Achilles tendon in normal subjects and in patients with chronic Achilles tendinopathy with the aim of establishing diagnostic sonographic criteria for chronic Achilles tendinopathy.…”

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Sonography of chronic Achilles tendinopathy: A case–control study

Leung

Griffith

2007

J of Clinical Ultrasound

101

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Purpose. To describe the sonographic appearance of Achilles tendon in normal subjects and patients with chronic Achilles tendinopathy with the aim of establishing diagnostic sonographic criteria for Achilles tendinopathy.Methods. A prospective, cross-sectional, case-control sonographic study of the Achilles tendon was undertaken. Thirty tendons in 21 patients and 100 tendons in 50 control subjects were selected. Sonographic assessment included tendon thickness, echogenicity, fibrillar pattern, and presence of calcifications. Power Doppler imaging was used to assess tendon vascularity. Paratendinous structures and plantar fascia were also examined.Results. Tendinopathic tendons were larger than normal tendons in both cross-sectional area and anteroposterior diameter. Hypoechoic areas within the tendon were more commonly seen in patients. Disruption of fibrillar pattern, increase in tendon vascularity, increased Kager's fat pad echogenicity, and paratenon thickening were solely seen in patients. Fluid in the retrocalcaneal bursa and calcaneal bony abnormalities were seen in both groups without a significant difference.Conclusion. Achilles tendinopathy results in enlargement, particularly of the mid-and distal portions of the tendon, disruption of fibrillar pattern, and increase in tendon vascularity. Additional signs are increased Kager's fat pad echogenicity and paratenon thickening. Tendon calcification, changes in retrocalcaneal bursae, and calcaneal contour are not specific for Achilles tendinopathy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Sonography of chronic Achilles tendinopathy: A case–control study

Leung

Griffith

2007

J of Clinical Ultrasound

101

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“…Hypervascularization should be studied with the foot in plantar flexion to reduce tendon pressure (Figs. 2, 4) [3].…”

Section: Disordersmentioning

confidence: 99%

“…The anterior margin of the tendon is flat both in the longitudinal (a) and the axial (b) scan. On the panoramic field-of-view scan (c) US shows the Achilles tendon (arrows) anteriorly in relation to the muscle belly of the flexor hallucis longus [1], to Kager's triangle [2] and in the pre-insertional area to the calcaneal tuberosity [3], to the posterior malleolus [4] and the posterior margin of the talus [5] of familial hypercholesterolemia due to xanthomatous deposits (triglycerides and cholesterol) [4].…”

Section: Disordersmentioning

confidence: 99%

US in mid-portion Achilles tendon injury

Gervasio¹,

Bollani²,

Biasio³

2013

J Ultrasound

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Ultrasound (US) is the primary imaging technique used to evaluate pathologies affecting the tendons, as the use of high frequency probes permits a detailed study of the structure and morphology of the area also during dynamic examinations. The mid-portion of the Achilles tendon is well evaluated both in normal and pathological conditions, such as tendinosis and peritendinitis as well as partial-thickness and full-thickness tears. The role of US is essential to the diagnosis and, therefore, also to treatment planning in major disorders affecting the Achilles tendon. US furthermore allows the clinician to monitor the effectiveness of treatment over time as well as the risk of recurrent rupture after surgery. Keywords Achilles tendon Á UltrasoundRiassunto L'esame ecografico è la tecnica di prima istanza nella valutazione della patologia dei tendini grazie alle indicazioni morfologiche e strutturali dettagliate che derivano dall'uso di sonde ad elevata frequenza e alla possibilità di esaminare i tendini anche durante manovre dinamiche. Il ventre tendineo d'Achille è ben valutabile sia in condizioni normali che patologiche quali le tendinosi, peritendiniti, rotture parziali e a tutto spessore. L'ecografia riveste un ruolo essenziale nella diagnosi e quindi nell'impostazione terapeutica delle principali affezioni del tendine d'Achille; consente inoltre di monitorare nel tempo l'efficacia dei trattamenti e nel post-operatorio il rischio di rottura recidiva del tendine. AnatomyThe Achilles tendon is the thickest and strongest tendon in the human body. It is 12-15 cm long; it originates from the aponeuroses of the medial, lateral and soleus gastrocnemius muscles (triceps surae) and is inserted into the posterior calcaneal tuberosity. It is the major plantar flexor of the foot and contributes to the maintenance of the upright position.Anteriorly, the Achilles tendon is connected to the muscle belly of the flexor hallucis longus (from which it is separated by the interposition of a mass of adipose tissue occupying Kager's triangle) and in the pre-insertional area it is connected to the calcaneal tuberosity from which it separated is by a synovial bursa, referred to as the deep retrocalcaneal bursa. Superficially it is in contact with the subcutaneous adipose tissue at the calcaneal tuberosity by the interposition of a synovial bursa (superficial retrocalcaneal bursa) (Fig. 1).In 90 % of cases the Achilles tendon is on the anteriormedial side in close relation to the tendon of the gracilis muscle, an accessory muscle whose tendon may insert on the posterior medial heel, the Achilles tendon or the flexor retinaculum of the ankle.The Achilles tendon presents a ribbon-like morphology. At the origin it appears as a flat thin band, and when proceeding distally it becomes thicker and acquires a crescent-shaped morphology whose posterior margin is convex. The anterior margin is flat or slightly concave, and in the pre-insertional area the anterior margin is moderately convex. The tendon consists of longitudinal bundles of...

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